Pub Date : 2019-07-26DOI: 10.5772/INTECHOPEN.88246
A. Plotski
Endometriosis in a postoperative scar is a secondary process in scars after surgical procedures affecting endometrium: cesarean section, hysterectomy, amniocentesis etc. Nevertheless scar endometriosis occurs also after general surgery – appendectomy, cholecystectomy, correction of hernias. The cause of surgical scar endometriosis is believed to be iatrogenic transplantation of endometrium to the surgical wound. Despite the ectopic location, endometrial tissue is able to respond to hormonal effects, thereby causing clinical signs of disease. Endometriosis of postoperative scar is a typical example of extragenital endometriosis. The most common presenting symptom of endometrioma in a scar is a palpable mass associated with cyclic pain and swelling during menses. When the patient complains are not cyclical (25-45% of patients with scar endometriosis) clinical diagnosis is impaired. The typical sonographic pattern of endometriomas is presence of subcutaneous nodule, hypoechoic with hyperechoic strands and irregular margins. Different types of hormonal therapy has been tried with minimal effects. That’s why for endometriosis of postoperative scar total surgical excision is considered to be golden standard for both diagnosis and treatment. In order to prevent scar endometriosis some measures have been proposed. But no measures of prevention have proved its efficiency and all these measures were suggested without any evident scientific corroboration.
{"title":"Endometriosis of Postoperative Scar","authors":"A. Plotski","doi":"10.5772/INTECHOPEN.88246","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.88246","url":null,"abstract":"Endometriosis in a postoperative scar is a secondary process in scars after surgical procedures affecting endometrium: cesarean section, hysterectomy, amniocentesis \u0000etc. Nevertheless scar endometriosis occurs also after general surgery – appendectomy, cholecystectomy, correction of hernias. The cause of surgical scar \u0000endometriosis is believed to be iatrogenic transplantation of endometrium to the surgical wound. Despite the ectopic location, endometrial tissue is able to respond to \u0000hormonal effects, thereby causing clinical signs of disease. Endometriosis of postoperative scar is a typical example of extragenital endometriosis. The most common \u0000presenting symptom of endometrioma in a scar is a palpable mass associated with cyclic pain and swelling during menses. When the patient complains are not cyclical \u0000(25-45% of patients with scar endometriosis) clinical diagnosis is impaired. The typical sonographic pattern of endometriomas is presence of subcutaneous nodule, \u0000hypoechoic with hyperechoic strands and irregular margins. Different types of hormonal therapy has been tried with minimal effects. That’s why for endometriosis of \u0000postoperative scar total surgical excision is considered to be golden standard for both diagnosis and treatment. In order to prevent scar endometriosis some measures \u0000have been proposed. But no measures of prevention have proved its efficiency and all these measures were suggested without any evident scientific corroboration.","PeriodicalId":94205,"journal":{"name":"Scars, burns & healing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75875964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-23DOI: 10.5772/INTECHOPEN.83582
I. Ghorbel, S. Moalla, A. Abid, Amir Karra, K. Ennouri
Electrical burns are a major cause of bodily harm due to the mechanism and effect of the lesions. This prompts us to study these lesions and their management in order to reduce the morbidity caused by this type of accident. In the event of an electric chock accident, the treatment is medico-surgical and is composed of two main phases: acute phase when general treatment is essential and subacute phase when local treatment is implemented. The study shows that conventional emergency decompression does not appear to reduce the amputation rate, the use of local and locoregional flaps in the initial phase (<21 days) carries a significant risk of suffering and necrosis, and also antithrom-botic prevention or the use of flaps does not seem to have an impact on healing delays.
{"title":"The Specificities of Electrical Burn Healing","authors":"I. Ghorbel, S. Moalla, A. Abid, Amir Karra, K. Ennouri","doi":"10.5772/INTECHOPEN.83582","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.83582","url":null,"abstract":"Electrical burns are a major cause of bodily harm due to the mechanism and effect of the lesions. This prompts us to study these lesions and their management in order to reduce the morbidity caused by this type of accident. In the event of an electric chock accident, the treatment is medico-surgical and is composed of two main phases: acute phase when general treatment is essential and subacute phase when local treatment is implemented. The study shows that conventional emergency decompression does not appear to reduce the amputation rate, the use of local and locoregional flaps in the initial phase (<21 days) carries a significant risk of suffering and necrosis, and also antithrom-botic prevention or the use of flaps does not seem to have an impact on healing delays.","PeriodicalId":94205,"journal":{"name":"Scars, burns & healing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77951686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-07DOI: 10.5772/INTECHOPEN.85411
L. Damkat-Thomas, J. Greenwood
Burn injury is a trauma that has variable scarring outcomes dependent on both the size and the depth of the burn. This chapter will discuss the pathophysiology of wound healing by both primary and secondary intention and its applicability to burn wounds. The importance of accurate assessment of burn depth and its impact on the primary treatment and subsequent scar outcome will be explored. Special anatomic areas such as the face, hands and neck will be highlighted. Skin grafting and skin substitutes as treatment options will be reviewed. Improvements in burn care have enabled people to survive larger burns that may once have proved fatal. The emphasis of treatment, once healing has been achieved, is now focused upon rehabilitation and scar management. Scar management strategies including pressure garments and silicone therapy are highlighted along with secondary scar revision strategies.
{"title":"Scarring After Burn Injury","authors":"L. Damkat-Thomas, J. Greenwood","doi":"10.5772/INTECHOPEN.85411","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85411","url":null,"abstract":"Burn injury is a trauma that has variable scarring outcomes dependent on both the size and the depth of the burn. This chapter will discuss the pathophysiology of wound healing by both primary and secondary intention and its applicability to burn wounds. The importance of accurate assessment of burn depth and its impact on the primary treatment and subsequent scar outcome will be explored. Special anatomic areas such as the face, hands and neck will be highlighted. Skin grafting and skin substitutes as treatment options will be reviewed. Improvements in burn care have enabled people to survive larger burns that may once have proved fatal. The emphasis of treatment, once healing has been achieved, is now focused upon rehabilitation and scar management. Scar management strategies including pressure garments and silicone therapy are highlighted along with secondary scar revision strategies.","PeriodicalId":94205,"journal":{"name":"Scars, burns & healing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74361243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-26DOI: 10.5772/INTECHOPEN.84127
G. Prezzavento
The issue of achieving esthetically pleasing surgical scars has gained prominence in recent years, with the emergence of the concept of the “imperceptible scar,” which is expected by patients of not only cosmetic but also reconstructive surgery. Current research in reconstructive surgery focuses on obtaining high-quality results in the minimum number of steps, with a view to “doing it right the first time.” However, there is no uniform approach to scar treatment, which is partly due to a lack of consensus regarding the most effective healing methods. This chapter aims at shedding new light to discussion by putting forward two different procedures that enhance scar results in cosmetic and reconstructive surgeries by applying a topical treatment with active ingredients and by combining cadaver and artificial skin as dermal substitutes, respectively. The effectiveness of these treatments is shown by means of objective, quantifiable data collected as a result of studies and postoperative follow-ups carried out at Hospital Alemán in Buenos Aires.
{"title":"Scars: A New Point of View in Plastic Surgery","authors":"G. Prezzavento","doi":"10.5772/INTECHOPEN.84127","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84127","url":null,"abstract":"The issue of achieving esthetically pleasing surgical scars has gained prominence in recent years, with the emergence of the concept of the “imperceptible scar,” which is expected by patients of not only cosmetic but also reconstructive surgery. Current research in reconstructive surgery focuses on obtaining high-quality results in the minimum number of steps, with a view to “doing it right the first time.” However, there is no uniform approach to scar treatment, which is partly due to a lack of consensus regarding the most effective healing methods. This chapter aims at shedding new light to discussion by putting forward two different procedures that enhance scar results in cosmetic and reconstructive surgeries by applying a topical treatment with active ingredients and by combining cadaver and artificial skin as dermal substitutes, respectively. The effectiveness of these treatments is shown by means of objective, quantifiable data collected as a result of studies and postoperative follow-ups carried out at Hospital Alemán in Buenos Aires.","PeriodicalId":94205,"journal":{"name":"Scars, burns & healing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73752997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-08DOI: 10.5772/INTECHOPEN.84178
R. Ogawa
Keloids and hypertrophic scars are fibroproliferative disorders of the skin. Research over the last decade has markedly improved our understanding of the pathogenesis of these scars, in particular, the fact that both disorders are caused by prolonged inflammation that prevents the orderly healing of injured or irritated skin. This protracted inflammatory response is due to genetic, systemic, and local risk factors. Genetic factors include single nucleotide polymorphisms, while systemic factors include hypertension, pregnancy-related and other hormones, and aberrant cytokine levels. An important local factor is the mechanical force (tension) on the scar. These observations have greatly aided the development of therapies for these once-intractable scars. As a result, these scars are now regarded as being completely treatable. At present, we believe that the following combination of three therapies most reliably achieves a complete cure: surgery followed by radiation and the prolonged daily use of corticosteroid tape/plaster. identifies four susceptibility loci for keloid in the population.
{"title":"Keloids and Hypertrophic Scars Can Now Be Treated Completely by Multimodal Therapy, Including Surgery, Followed by Radiation and Corticosteroid Tape/Plaster","authors":"R. Ogawa","doi":"10.5772/INTECHOPEN.84178","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84178","url":null,"abstract":"Keloids and hypertrophic scars are fibroproliferative disorders of the skin. Research over the last decade has markedly improved our understanding of the pathogenesis of these scars, in particular, the fact that both disorders are caused by prolonged inflammation that prevents the orderly healing of injured or irritated skin. This protracted inflammatory response is due to genetic, systemic, and local risk factors. Genetic factors include single nucleotide polymorphisms, while systemic factors include hypertension, pregnancy-related and other hormones, and aberrant cytokine levels. An important local factor is the mechanical force (tension) on the scar. These observations have greatly aided the development of therapies for these once-intractable scars. As a result, these scars are now regarded as being completely treatable. At present, we believe that the following combination of three therapies most reliably achieves a complete cure: surgery followed by radiation and the prolonged daily use of corticosteroid tape/plaster. identifies four susceptibility loci for keloid in the population.","PeriodicalId":94205,"journal":{"name":"Scars, burns & healing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74854261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1177/2059513119880301
Christos Iosifidis, I. Goutos
Introduction: Percutaneous collagen induction (PCI) or needling techniques are increasingly popular in the reconstructive and aesthetic arena. The underlying mechanisms of action rest on producing a pattern of non-ablative and non-confluent puncture wound pattern to the dermis with a resulting regenerative effect to the skin. Methods: A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to level of evidence as well risk of bias. Results are presented in descending order of evidence for non-atrophic scars. Discussion: On the basis of level 1 evidence currently available, the combination of needling and silicone gel can improve the short-term pliability, height and vascularity of hypertrophic and keloid scars. According to level 2 evidence, needling alongside spray keratinocytes can produce a statistically significant improvement to patient/observer scar ratings and improve pigmentation in hypopigmented burn scars at 12-month follow-up. Results from mixed cohort studies also point towards needling having a beneficial effect on fat graft retention. Level 3 data suggest that needling can render significant resurfacing effects to both mature and actively hypertrophic burn scars at 12-month follow-up based on objective scar scales; furthermore, favourable histological changes are seen, including better collagen alignment in the dermis and increased epidermal thickness. Conclusion: Needling techniques are promising adjuncts to non-atrophic scar management. Further research with long-term follow-up and comparative design protocols incorporating other resurfacing modalities is warranted before the exact value of needling is delineated in scar management protocols. Lay Summary Needling techniques are increasingly popular and involve the use of a device to produce numerous tiny perforations in the skin, stimulate collagen production and resurface the treated area. We undertook this study to find out whether the use of needling can have a beneficial effect on scars that are raised (hypertrophic and keloidal). We conclude that, at present, there is some evidence that needling in combination with silicone gel can improve the appearance of bulky scars in the short term; additionally needling can enhance the appearance of discoloured burn scars if used in combination with spray skin cell preparations and improve the take of fat transferred to the treated area. There are also a number of studies that have confirmed the beneficial effects of needling in the architecture of treated skin, which include improved skin structure and increased collagen production. Further research is eagerly awaited to determine the exact position of needling techniques in scar management protocols.
导读:经皮胶原诱导(PCI)或针刺技术在重建和美学领域越来越受欢迎。潜在的作用机制在于产生一种非烧蚀性和非融合性的真皮层穿刺伤口模式，从而对皮肤产生再生效果。方法:采用PubMed Medline、Embase、Web of Science等软件进行详细的英文文献综述;根据证据水平和偏倚风险对稿件进行评估和分类。结果呈现在证据降序为非萎缩性疤痕。讨论:根据现有的1级证据，针刺和硅胶结合可以改善增生性瘢痕和瘢痕疙瘩的短期柔韧性、高度和血管性。根据二级证据，在12个月的随访中，针刺和喷雾角质形成细胞可以对患者/观察者的疤痕评分产生统计学上显著的改善，并改善低色素烧伤疤痕的色素沉着。混合队列研究的结果也指出，针刺对脂肪移植体保留有有益的影响。3级数据表明，在12个月的随访中，根据客观疤痕量表，针刺对成熟和活动性增生性烧伤疤痕都有显著的表面修复效果;此外，可以看到有利的组织学变化，包括真皮中更好的胶原排列和表皮厚度增加。结论:针刺技术是治疗非萎缩性瘢痕的有效辅助手段。在疤痕管理方案中明确针刺的确切价值之前，有必要进行长期随访和比较设计方案，并结合其他表面修复方式进行进一步研究。针刺技术越来越受欢迎，它包括使用一种装置在皮肤上产生许多微小的穿孔，刺激胶原蛋白的产生，并使治疗区域重新出现。我们进行这项研究是为了找出针刺是否对凸起的疤痕(肥厚性和瘢痕疙瘩)有有益的影响。我们的结论是，目前，有一些证据表明，针刺结合硅胶可以在短期内改善笨重疤痕的外观;此外，如果与喷雾皮肤细胞制剂结合使用，针刺可以增强变色烧伤疤痕的外观，并改善转移到治疗区域的脂肪的吸收。也有一些研究证实了针刺对治疗后皮肤结构的有益影响，包括改善皮肤结构和增加胶原蛋白的产生。进一步的研究迫切需要确定针刺技术在疤痕管理方案中的确切位置。
{"title":"Percutaneous collagen induction (microneedling) for the management of non-atrophic scars: literature review","authors":"Christos Iosifidis, I. Goutos","doi":"10.1177/2059513119880301","DOIUrl":"https://doi.org/10.1177/2059513119880301","url":null,"abstract":"Introduction: Percutaneous collagen induction (PCI) or needling techniques are increasingly popular in the reconstructive and aesthetic arena. The underlying mechanisms of action rest on producing a pattern of non-ablative and non-confluent puncture wound pattern to the dermis with a resulting regenerative effect to the skin. Methods: A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to level of evidence as well risk of bias. Results are presented in descending order of evidence for non-atrophic scars. Discussion: On the basis of level 1 evidence currently available, the combination of needling and silicone gel can improve the short-term pliability, height and vascularity of hypertrophic and keloid scars. According to level 2 evidence, needling alongside spray keratinocytes can produce a statistically significant improvement to patient/observer scar ratings and improve pigmentation in hypopigmented burn scars at 12-month follow-up. Results from mixed cohort studies also point towards needling having a beneficial effect on fat graft retention. Level 3 data suggest that needling can render significant resurfacing effects to both mature and actively hypertrophic burn scars at 12-month follow-up based on objective scar scales; furthermore, favourable histological changes are seen, including better collagen alignment in the dermis and increased epidermal thickness. Conclusion: Needling techniques are promising adjuncts to non-atrophic scar management. Further research with long-term follow-up and comparative design protocols incorporating other resurfacing modalities is warranted before the exact value of needling is delineated in scar management protocols. Lay Summary Needling techniques are increasingly popular and involve the use of a device to produce numerous tiny perforations in the skin, stimulate collagen production and resurface the treated area. We undertook this study to find out whether the use of needling can have a beneficial effect on scars that are raised (hypertrophic and keloidal). We conclude that, at present, there is some evidence that needling in combination with silicone gel can improve the appearance of bulky scars in the short term; additionally needling can enhance the appearance of discoloured burn scars if used in combination with spray skin cell preparations and improve the take of fat transferred to the treated area. There are also a number of studies that have confirmed the beneficial effects of needling in the architecture of treated skin, which include improved skin structure and increased collagen production. Further research is eagerly awaited to determine the exact position of needling techniques in scar management protocols.","PeriodicalId":94205,"journal":{"name":"Scars, burns & healing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059513119880301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43963987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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